Aggressive New Approaches Needed on PMTCT

This post is by Center Director Christine Lubinski, reporting from the 2009 IAS conference in Cape Town.

Dramatic scale-up and innovative approaches are critically needed to improve prevention of mother-to-child transmission, Elaine Abrams, of Columbia University’s International Center for AIDS Care and Treatment Programs, said at an IAS conference session on PMTCT today. In a stirring presentation, Abrams noted the urgency of ensuring that HIV-infected women and their children have access to continuity of high-quality health care and other services that are nested in maternal/child health services in the community. A great deal of work still needs to be done in that arena, said Abrams, who is director of ICAP’s MTCT-Plus Initiative, a care and treatment program for HIV-infected women and their families in resource-constrained settings.

For starters, only 43% of HIV-positive pregnant women receive antiviral therapy, and the percentage of infants who receive ARV interventions is even lower. Some countries in southern Africa do better than others. But Abrams called for reconceptualizing this intervention as a component of HIV care and treatment for pregnant women, children and families. She said program implementers and others need to identify the population of infected women and children across the range of maternal/child health services. She called for maximizing available biomedical interventions by ensuring that mothers and babies receive potent ART regimens for treatment and prevention prophylaxis.

Abrams said HIV testing should be widely available through maternal/child health services. She highlighted several successful models, including the implementation of partner testing in Ethiopia and efforts reported upon by Rollins et all to integrate HIV testing, including infant testing, in immunization clinics. From Abrams’s perspective, HAART should be offered to all women of child-bearing age with CD4 counts under 350 and multiple-drug regimens should be offered to HIV-infected women with higher CD4 counts during pregnancy, coupled with infant prophylaxis to newborns. The goal of these programs should be enhance HIV-free survival for children and improve maternal health.

0 thoughts on “Aggressive New Approaches Needed on PMTCT”

Regarding PMTCT, one very effective solution is long-term and/or permanent contraception. We must not miss any opportunities to offer safe and effective contraception (such as IUD) to women and men (vasectomy) with HIV. It should be the first thing we offer after HIV testing.